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We aimed to examine different effects of the current capability of and changes in self-management strategies on improving health behavior and psychological health (satisfaction of life, depression, and anxiety) after 6 months in cancer patients.A prospective cohort study was conducted, including 540 cancer patients. We measured cancer patients' self-management strategies' capability with Smart Management Strategies for Health (SMASH) Assessment Tool (SAT) baseline scores and changes with SMASH change scores based on a clinically meaningful 10% change of the scores. We conducted adjusted multivariate multiple logistic regression analyses using the stepwise selection method between SMASH baseline and health behavior, satisfaction with life (SWL), depression, and anxiety and between SMASH changes and health behavior, SWL, depression, and anxiety.256 cancer patients completed both the first and second surveys. While various SMASH capabilities positively affected each health behavior, SWL, depression, and anxiety, the positive-reframing strategy at baseline only affected all health behavior, SWL, and depression. However, based on SMASH changes, using the positive-reframing strategy a lot for 6 months adversely affected some physical health behaviors' practice (balanced diet and stop smoking and drinking). Changes in the life value pursuing strategy only positively affected HB (proactive living) and anxiety.SMASH baseline and change scores were generally associated with practicing cancer patients' health behaviors, lower depression, and anxiety. However, it is necessary to consider that excessively using the positive-reframing strategy would interfere with practicing a balanced diet and stopping smoking and drinking behaviors.

Although the relationship between subjective well-being (SWB) and suicidal ideation (SI) has been illustrated in previous research, few studies have conceptualized SWB as a comprehensive measure of life satisfaction in multiple domains, nor have they considered possible mediators such as depressive symptoms. Therefore, the present study aimed to identify dimensions of SWB correlated with SI, and to analyze associations among SWB sub-domains, depressive symptoms, and SI in a community population. A total of 1200 community adults in South Korea, aged 20-86 years, completed self-report questionnaires on demographics, depressive mood (Patient Health Questionnaire-9 [PHQ-9]), SI (item 9 of the PHQ-9), and 14 SWB sub-domains (Subjective Well-Being Inventory). Factors associated with SI, and interactions among SI, depressive mood, and SWB, were identified by logistic regression and phenotype network analyses, respectively. The five main factors influencing the regularized partial correlation network were life satisfaction, self-blame, job, hopelessness, and fatigue. Pathways were observed from work-life balance and life satisfaction to hopelessness; from self-blame and fatigue to safety and health; and from sleep disturbance, concentration difficulties, self-blame, and hopelessness to SI. Making job activities more emotionally rewarding, the potential for career progression and regular work hours could address anhedonia, hopelessness and sleep disturbance, respectively, thus enhancing SWB and reducing SI in the community population.

Purpose: First, we aimed to develop and validate simple prediction models for QoL as a primary outcome and health statuses as secondary outcomes considering the use in actual clinical practice. Second, we aimed to interpret the prediction models using explainable artificial intelligence (XAI) methods by extracting important features and dependence plots. Third, we aimed to predict and interpret individual outcomes and visualize the results using the SHapley Additive explanation (SHAP) XAI method. This study's ultimate goal was to provide customized healthcare services for cancer survivors to improve their QoL and health statuses.Methods: In this prospective cohort study with a web-based survey, we established the prediction model for QoL and health statuses and compared the performance with ensemble methods such as decision trees, random forest, gradient boosting, eXtreme Gradient Boost (XGBoost), and LightGBM. After the model comparison, we selected the XGBoost model for further analysis. We demonstrated critical features of the QoL and each health status separately and extracted the individual prediction result in the XGBoost model using SHAP. Results: After data preprocessing and model selection, the final data set contained 256 cancer survivors with 38 predictive features. On repeated stratified K-fold validation, the XGBoost predictive model for the QoL showed high performance. The performance of the XGBoost predictive model for each health status (mental, social, and spiritual) was also good, except for physical health status. The important features of the above predictive models were different. In addition, our study showed a specific method of providing personalized healthcare services using the individual prediction results with SHAP.Conclusions: This study was the first to develop and validate predictive models for the QoL and health status in cancer survivors, interpret the models, and provide a customized healthcare service with XAI technology. Implications for Cancer Survivors: Our results can contribute to opening a new horizon in providing personalized healthcare services for cancer survivors with a web-based method.

In the cancer-care continuum, self-management can help cancer patients regardless of their treatment plan or cancer stage. However, research examining self-management strategy clusters considering cancer stages is lacking. Thus, we examined self-management strategy clusters considering cancer stages and the effects of self-management strategy clusters on quality of life (QoL) and overall health status.A total of 256 patients who completed both baseline and second surveys for a 6-month period ultimately participated in this prospective cohort study. To identify the interrelationship between self-management strategies measured by the Smart management strategies for health assessment tool (SAT), we conducted cluster analysis using a principal component analysis in varimax rotation and the k-mean clustering method. We also performed multivariate-adjusted analyses in QoL and overall health status comparisons by dividing the cancer stage into early (I, II) and advanced (III, IV).All patients experienced two domains of self-management strategies concurrently. However, self-management strategy clusters differed by cancer stage, and the effect of self-management strategy clusters on quality of life and overall health status also differed. Self-management strategy clusters effectively improved the quality of life and overall health status of the entire cohort of patients, even in patients with advanced-stage cancer.This study revealed that the pattern of using self-management strategies might differ by cancer stage. The strategy cluster positively affected QoL and overall health status in cancer patients. Identifying the self-management clusters of cancer patients with different cancer stages may have clinical implications for supporting their health management.

BACKGROUND Despite the importance of improving the quality of life (QoL) and overall health status (physical, mental, social, and spiritual health status) of cancer patients and survivors, the prediction model for QoL and health status and the interpretation of the model are insufficient. As self-management strategies were essential for improving the QoL and health status in cancer patients, we tried to develop simple prediction models using only self-management strategies and personal characteristics such as sociodemographic and clinical variables. OBJECTIVE First, we aimed to develop and validate simple prediction models for QoL as a primary outcome and health statuses as secondary outcomes considering the use in actual clinical practice. Second, we aimed to interpret the prediction models using explainable artificial intelligence (XAI) methods by extracting important features and dependence plots. Third, we aimed to predict and interpret individual outcomes and visualize the results using the XAI method called SHapley Additive explanation (SHAP). This study's ultimate goal was to provide customized healthcare services for cancer patients and survivors to improve their QoL and health statuses. METHODS In this prospective cohort study with a web-based survey, we established the prediction model for QoL and health statuses and compared the performance with ensemble methods such as decision trees, random forest, gradient boosting, eXtreme Gradient Boost (XGBoost), and LightGBM. After the model comparison, we selected the XGBoost model for further analysis. We demonstrated critical features of the QoL and each health status separately and extracted the individual prediction result in the XGBoost model using SHAP. RESULTS After data preprocessing and model selection, the final data set contained 256 cancer patients with 38 predictive features. On repeated stratified K-fold validation, the XGBoost predictive model for the QoL showed high performance: area under the receiver operating characteristic curve (AUROC) of 0.80 (95% CI, 0.78-0.82) and area under the precision-recall curve (AUPRC) of 0.96 (95% CI, 0.95-0.97). The performance of the XGBoost predictive model for each health status was 0.66 (95% CI, 0.65-0.67) for AUROC and 0.77 (95% CI, 0.75-0.79) for AUPRC in predicting physical health status, 0.71 (95% CI, 0.69-0.73) for AUROC and 0.90 (95% CI, 0.89-0.92) for AUPRC in predicting mental health status, 0.77 (95% CI, 0. 75-0.79) for AUROC and 0.96 (95% CI, 0.95-0.97) for AUPRC in predicting social health status, 0.75 (95% CI, 0.74-0.76) for AUROC and 0.87 (95% CI, 0.85-0.89) for AUPRC in predicting spiritual health status. The important features of the above predictive models were different. The top three important features of the QoL predictive model were the activity coping strategy, the change values of the self-implementing strategy, and the proactive problem-solving strategy, which were all self-management strategies for cancer patients. Our study also showed a specific method of providing personalized healthcare services. CONCLUSIONS To our knowledge, this study was the first to develop and validate interpretable predictive models for the QoL and health status in cancer patients and suggest the potential of providing customized healthcare with a specific application for cancer patients using the XAI technology.

BACKGROUND/OBJECTIVES Numerous school-based weight control programs have been initiated for weight loss among adolescents. However, the relationship between these programs and inappropriate weight control efforts, dietary habits and behavior of students, have not been investigated sufficiently. This study was undertaken to investigate the association between body mass index (BMI) of adolescents, and their health status and inappropriate weight-control efforts. We further examined the relationship between attendance to school-based weight-control programs and attempting inappropriate weight-control efforts, dietary habits, and behavior. SUBJECTS/METHODS A survey of 1,742 students was conducted in Korea. Logistic regression was used to assess differences in the health status (grouped by BMI and improper weight control) and dietary habits, based on attendance to the weight-control programs. RESULTS Obese students were significantly more dissatisfied with physical, mental and spiritual health. Students who attended weight-control programs were likely to be underweight (P < 0.001), whereas those who did not attend weight-control programs were likely to attempt weight control improperly (P < 0.001). Students who participated in the program also had relatively healthy dietary habits (P < 0.001-0.027), and students who did not attend had comparatively unhealthy dietary habits (P < 0.001-0.008). Students who attended weight-control programs were likely to be underweight (P < 0.001) with relatively healthy dietary habits (P < 0.001-0.027), whereas students who did not attend the programs were likely to attempt weight control improperly (P < 0.001) and had comparatively unhealthy dietary habits (P < 0.001-0.008). CONCLUSIONS Attending school-based weight-control programs was significantly associated with not attempting inappropriate weight-control efforts, as well as following healthy dietary habits. Our data indicates that offering school-based weight-control programs is valuable to student health, and is anticipated to reducing the public health burden.

Self-management has become the dominant care model for chronic disease management. This study aimed to investigate the effect of changes in self-management strategies on the clinical outcomes of chronic diseases. Two hundred ninety-seven patients with one or more chronic disease (diabetes, dyslipidemia, or hypertension) were registered and followed in this prospective cohort study. We compared differences in the changes in clinical outcomes from baseline to 6 months according to the improvement of self-management strategies by analysis of covariance. Diabetic patients with improved self-management strategies showed a significantly greater change in HbA1c levels compared to patients without improvement of self-management strategies (group difference in HbA1c = 0.51%). In hypertensive patients, systolic and diastolic blood pressure (BP) showed a significant decline in the patients with improved self-management strategies (group difference in systolic BP = 6.2 mmHg and in diastolic BP = 5.5 mmHg). Clinical outcomes improved significantly when self-management strategies improved in people with a poor self-management strategy at baseline. This study suggests that improvements in self-management strategies are associated with an improvement in clinical outcomes among patients with chronic diseases, especially for those with an initially poor self-management strategy.

This study aimed to investigate the general South Korean public attitudes toward the legalization of euthanasia or physician-assisted suicide (EAS) and examine the reasons underpinning these attitudes. From March–April 2021, we conducted a cross-sectional survey of a representative national sample of 1000 South Koreans aged 19 years or older. Three in four participants (76.4%) expressed positive attitudes toward the legalization of EAS. Participants who agreed with this legalization reported “meaninglessness of the rest of life” and “right to a good death” as their main reasons. Participants who disagreed with the legalization of EAS reported “respect for life”, “violation of the right to self-determination”, “risk of abuse or overuse”, and “violation of human rights” as theirs. In the multivariate logistic regression analyses, participants with poor physical status (adjusted odds ratio [aOR]: 1.41, 95%; confidence interval [CI]: 1.02–1.93) or comorbidity (aOR: 1.84, 95%; CI: 1.19–2.83) showed positive attitudes toward the legalization of EAS. In summary, most of the general South Korean population regards the legalization of EAS positively, especially participants with poor physical status or comorbidity.

This study aimed to present normative data of Quality of life (QoL) and to evaluate the relationship between sociodemographic factors, multidimensional QoL and depression. A questionnaire including the Short Form-12 (SF-12) for physical and mental health-related QOL (HRQOL), the McGill Quality of Life questionnaire (MQOL) for existential well-being and social support-related QOL, and the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms was designed and administered to 1200 Korean participants as part of a population-based survey. The MQOL of the entire and female population decreased notably with age (p $3000 reported a better mental HRQOL (aOR = 1.42 and 1.38). Those who were educated at higher than college level or were religious reported a worse mental HRQOL (aOR = 0.70 and 0.69). Unlike QOL measured by the SF-12, MQOL was lower among women (aOR = 0.77) and participants who were divorced or separated (aOR = 0.23 for existential well-being and 0.40 for social support). Participants who were educated at higher than college level (aOR = 1.51) and those living in a city/country reported a better MQOL (aOR = 1.50 for existential well-being and 1.60 for social support). Among the QOL scores that were significantly related to depression, existential well-being-related QOL had the highest aOR (aOR = 38.15), followed by physical HRQOL score (aOR = 4.52). Further consideration is needed to raise awareness of the need for evaluating multidimensional QOL in the general population.

A caregiver’s prognostic awareness can affect clinical decisions for the patient. The purpose of this study was to examine the impact of family caregivers’ prognostic awareness on the quality of life (QOL) and emotional state of both patients with advanced cancer and their caregivers. This prospective cohort study was conducted from December of 2016 to January of 2018. A total of 159 patients with advanced cancer and an equal number of caregivers participated. The investigation tools used include the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C15-Palliative, the McGill Quality of Life Questionnaire, and the Patient Health Questionnaire-9, and evaluation was performed at baseline, 3 months, and 6 months. Covariance analysis with a general linear modeling was used to compare changes in quality of life scores according to the caregivers’ awareness of the prognosis. Mean patient overall QOL score increased in the group of caregivers who were aware of prognosis and decreased in the caregivers who were not aware of the prognosis (p = 0.018). The changes over time in the patients’ QOL scores associated with symptoms improved with caregiver awareness (pain, p = 0.017; dyspnea, p = 0.048; appetite loss, p = 0.045). The percentage of depressed patients was smaller after 3 months in the group with caregivers aware of the prognosis (baseline to 3 months p = 0.028). Caregivers who did not understand their patients’ prognosis exhibited better existential well-being (p = 0.036), and the incidence of depression was lower in this group at 3 months (p = 0.024). Caregivers’ prognostic awareness may improve the quality of life and mood in patients with advanced cancer; however, this awareness may harm the quality of life and mood of the caregivers. These results may aid in developing in-depth interventions regarding prognosis for both patients and their caregivers.

OBJECTIVES To investigate the efficacy of health coaching and a web-based program on survivor physical activity (PA), weight, and distress management among stomach, colon, lung and breast cancer patients. METHODS This randomised, controlled, 1-year trial conducted in five hospitals recruited cancer survivors within 2 months of completing primary cancer treatment who had not met ≥1 of these behavioural goals: (i) conducting moderate PA for at least 150 minutes/week or strenuous exercise for over 75 minutes per week or, in the case of lung cancer patients, low or moderate intensity exercise for over 12.5 MET per week, (ii) maintaining normal weight, and (iii) attaining a score >72 in the Post Traumatic Growth Inventory (PTGI). Participants were randomly assigned to one of three groups: the control group, a web-only group, or a health coaching + web group. The primary endpoint was based on a composite of PA, weight, and PTGI score at 12 months. RESULTS Patients in the health coaching + web group (difference = 6.6%, P = .010) and the web-only group (difference = 5.9%, P = .031) had greater overall improvements across the three-outcome composite than the control group. The health coaching + web group had greater overall improvement in PTGI (difference = 12.6%; P

As “mukbang” (eating broadcast) becomes increasingly widespread, there is growing interest about the impact of mukbang on public health. This study aimed to analyze the content of mukbang YouTube videos, as well as news articles related to mukbang and the association between watching mukbang videos and health habits. We analyzed 5952 YouTube mukbang videos, 5265 news articles, and a survey of 1200 people in Korea. In this study, we confirmed that the provocative content of mukbang YouTube videos, such as overeating, was related to video popularity (p

Objective: The objective of this study was to investigate the impact of experiencing diverse, multi-dimensional health promotion programmes in school on students’ self-reported health status. Design: Cross-sectional design. Methods: We surveyed 2,568 students from 15 middle schools and 15 high schools in Korea between August 2014 and January 2015. Self-reported information related to health status, attendance at physical, social, mental or spiritual health promotion programmes, and socio-demographics was collected and analysed. Results: Male students, students aged 15 and below, and students living in rural areas were more satisfied with their health status. Regardless of programme type, the number of health promotion programmes attended correlated positively with better overall health status ( p Conclusion: Participation in health promotion programmes was found to be related not only to the targeted health status but also to other aspects of subjective health.

Little has been determined regarding the association between patients’ and families’ illness understanding and preferences for medical care. We aimed to evaluate the association of illness understanding with advance care planning (ACP) and preferences for end-of-life care, such as aggressive care, early palliative care (EPC), and hospice care, among advanced cancer patients and their family caregivers. Patients were recruited for a prospective cohort study at outpatient and inpatient facilities in nine university hospitals in Korea (n = 150), and their primary family caregivers were also asked to participate (n = 101). Data on ACP and end-of-life care preferences were collected only at baseline in the cohort study with optional questions and were used to analyze these study results. Patients with illness understanding were more likely to have documented physician orders for life-sustaining treatment (POLSTs) (adjusted odds ratio [aOR] of 4.94) and to have discussed ACP with their families (aOR 2.15) than those who did not. Being expected to live for several months, they were unlikely to prefer active treatment. Caregivers understanding patients’ illness were more likely to write advance directives (ADs) and to discuss ACP; furthermore, they had already discussed ACP with family members. They did not prefer active treatment or life-sustaining treatments when their family members were expected to die within a few weeks. There was no significant association between illness understanding and preferences for EPC. Accurately recognizing an incurable disease is associated with preferences for more ACP and less aggressive care but not with preferences for EPC or hospice care among both advanced cancer patients and their family caregivers.

Background People face many obstacles to overcoming crisis in life and proactively manage life crises. This study aimed to evaluate the association of self-management strategy with subjective health and well-being for the general South Korean population. Methods We recruited 1,200 respondents using an equal-probability sampling method from March to May 2018. A questionnaire including life version of the Smart Management Strategy for Health Assessment Tool (SAT-Life), the five Health Status Questionnaire, Short Form-12, McGill Quality of Life Questionnaire (MQOL), Patient Health Questionnaire-9 (PHQ-9), and Satisfaction With Life Scale (SWLS) was administered to participants. Results In multiple stepwise logistic regression model adjusted with basic demographic variables (age, sex, region, education and monthly income level), core strategy was independently associated with physical, mental, social, spiritual, and general health status (adjusted odds ratios [aORs], 1.97–2.92). Preparation strategy was independently associated with physical, mental, spiritual, and general health status (aORs, 2.36–3.31). Implementation strategy was independently associated with physical, social, spiritual, and general health status (aORs, 2.22–2.42). Core strategy and implementation strategy were independently associated with higher Physical Component Score (aORs, 2.21–2.29) and higher Mental Component Score (aORs, 1.68–1.76). Core strategy and preparation strategy were independently associated with lower PHQ-9 (aORs, 2.63–3.74). Pearson's correlation coefficients between scores on SAT-Life and the other factors (MQOL social support, MQOL spiritual well-being, and SWLS) explain having significant correlations ranging from 0.41–0.43. Conclusion Self-management strategies of health might be encouraged to manage subjective health and well-being outcomes., Graphical Abstract

Objective We aimed to develop the Workplace Parent Index (WPI) as an assessment tool of family-friendly practice in the workplace and validate its psychometric properties. Methods The development of the WPI included three phases: item generation, scale construction, and field testing. Participants were 1,000 parents, aged 18 or more years old, who completed the WPI online and measures of competency of parentship, life satisfaction, and positive growth after experiencing a traumatic event. Results The WPI comprised 80 items and five domains: Governance and Infrastructure, Planning and Communications, Action-Pregnancy and Childbirth, Action-Childrearing, and Monitoring and Feedback. All subscales of the WPI demonstrated high internal consistency reliability and correlated with other scales as expected in support of concurrent and predictive validity. Conclusions The WPI demonstrated excellent psychometric properties that can be used to assess comprehensive family-friendly practices in the workplace when addressing the need and prioritizing the allocation of resources for workplace parentship program initiatives.

ObjectivesWe developed the Health-Friendly Activity Index (HFAI) to comprehensively measure the health-friendly activities of corporations or organisations. We validated the developed tool and reported on its use as an assessment tool to improve consumers’ health-related outcomes.DesignThis was a cross-sectional study.SettingDevelopment of the HFAI questionnaire followed a three-phase process: item generation, item construction and validation with field testing. Using relevance and feasibility criteria, we developed a 105-item questionnaire with six domains (Governance and Infrastructure, Needs Assessment, Planning, Implementation, Monitoring and Feedback, and Outcomes).ParticipantsTo assess the sensitivity and validity of the questionnaire, the HFAI and Contribution Assessment Tool for Consumer’s Health (CATCH) were administered to 302 participants (151 employers and 151 employees) from 151 Korean companies.Primary outcome measuresThe CATCH measured the contribution of each company to the physical, mental, social and spiritual health of its consumers. To estimate the reliability and validity of all six HFAI domains and their respective scales, Cronbach’s α coefficients and correlation coefficients were used.ResultsEach domain and scale of the HFAI exhibited a Cronbach’s α coefficient between 0.80 and 0.98 for the employers and employees. The overall HFAI and its six domains correlated significantly and positively with all health outcomes such as physical, mental, social and spiritual status scores evaluated using the CATCH (Spearman’s correlation range: 0.37–0.68).ConclusionThe HFAI, a unique assessment tool with acceptable psychometric properties, can help corporate managers assess their health-friendly activities.

We aimed to compare the health-related quality of life and health behaviors of acute leukemia (AL) survivors with that of the general population from two cohorts. AL survivors (n = 149) completed a set of questionnaires to evaluate quality of life, mental status, and health behaviors. AL survivors had more physical and mental difficulties (problems with usual activities, 15% vs. 5%, p

We identify the most associative factors among existential well-being, health-related quality of life, and health behaviors' sub-factors for cancer patients' suicidal ideation (SI) to develop practical intervention tools for general cancer patients in South Korea.We surveyed 766 cancer patients from two hospitals in South Korea. The eligibility criteria were as follows: 18 years of age or older, diagnosed with cancer, aware of the stage, and capable of understanding the purpose of the study.We performed a multidimensional multivariate analysis to find the factors that are most associated with SI for cancer patients.The results showed that life worthwhile (adjusted odds ratio (aOR), 3.946; 95% CI, 1.64-9.48), social functioning (aOR, 2.817; 95% CI, 1.19-6.65), and living with loved ones (aOR, 0.353; 95% CI, 0.15-0.84) were the most predictive factors for SI.To prevent SI in cancer patients, it might be necessary to help them feel that their lives are worthwhile while helping them maintain a high degree of social health.It is important to help cancer patients value their life and lead the high-quality social life to reduce their SI.

Self-management strategies are essential for improving prognosis in chronic illnesses. This study aimed to investigate the association between comorbidity and self-management strategies. A total of 700 patients with one or more chronic diseases including diabetes, dyslipidemia, hypertension, osteoporosis, chronic lung disease, chronic kidney disease and arthritis were enrolled. A questionnaire including the Smart Management Strategy for Health Assessment Tool Short Form (SAT), the Short Form-12, the McGill Quality of Life questionnaire, and the Patient Health Questionnaire-9 was administered to participants. The trend of each SAT according to number of comorbidities was evaluated, and the difference in quality of life and depression according to self-management strategies was examined in the model classified by the number of diseases. Self-management strategy scores tended to decrease as the number of comorbidities increased from one to four (p-value: 0.001 to 0.008). Regardless of the number of comorbidities, the MQOL score was higher in the good self-management strategy group (p

Self-management has become the dominant care model for chronic disease management. This study aimed to investigate the effect of changes in self-management strategies on the clinical outcomes of chronic diseases.Two hundred ninety-seven patients with one or more chronic disease (diabetes, dyslipidemia, or hypertension) were registered and followed in this prospective cohort study. We compared differences in the changes in clinical outcomes from baseline to 6 months according to the improvement of self-management strategies by analysis of covariance.Diabetic patients with improved self-management strategies showed a significantly greater change in HbA1c levels compared to patients without improvement of self-management strategies (group difference in HbA1c = 0.51%). In hypertensive patients, systolic and diastolic blood pressure (BP) showed a significant decline in the patients with improved self-management strategies (group difference in systolic BP = 6.2 mmHg and in diastolic BP = 5.5 mmHg). Clinical outcomes improved significantly when self-management strategies improved in people with a poor self-management strategy at baseline.This study suggests that improvements in self-management strategies are associated with an improvement in clinical outcomes among patients with chronic diseases, especially for those with an initially poor self-management strategy.

BACKGROUND: For chronic disease management, self-management strategies are essential to achieve sustained improvement. OBJECTIVE: Our study evaluated the efficacy of health coaching and a self-management strategy–based electronic program on self-management strategies for patients with osteoporosis, chronic respiratory disease, or arthritis. DESIGN: Three-arm randomized controlled trial, pilot study PARTICIPANTS: Fifty-four participants INTERVENTIONS: The first intervention group (n = 53) received a self-management strategy–based electronic program and 12 weeks of health coaching (20 sessions). The second intervention group received the information and communications technology (ICT) program; the control group received usual care and an educational booklet about self-management of chronic diseases. MAIN MEASURES: The primary outcome was the difference in the change of the mean of self-management strategy scores. Secondary outcomes included depression (PHQ-9), physical activity (Godin Leisure Exercise Questionnaire), and health habit maintenance (transtheoretical model) after 12 weeks in the program. KEY RESULTS: The combination of health coaching and ICT was superior to control group (change 18.5 vs. − 2.6, adjusted difference = 24.5, p < 0.001); however, the ICT alone group was not superior to the control group (change 8.0 vs. − 2.6, adjusted difference = 8.0, p = 0.156). As a result of evaluating the change in the percentage of people with positive stage changes in the transtheoretical model of health habits, regular exercise (p = 0.008), a balanced diet (p = 0.005), helping others (p = 0.001), and living with loved ones (p = 0.038) showed significant differences. There was no significant difference in the changes in percentage of patients with depressive symptoms in comparison with control group; however, there was in comparison with control group among groups (p = 0.033). Compared to the control group, the proportion of patients who achieved an exercise amount of 12.5 MET or higher was significantly higher (p = 0.028) in the health coaching and ICT group. CONCLUSIONS: The combination of ICT + health coaching led to improvement in self-management as well as in increasing exercise, and several healthy behaviors. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03294057

In Korean adults aged 50 years and older, the overall risk of fractures increased with greater BMI variability among both men and women, specifically, spinal fractures for men and both spinal and hip fractures for women. The bone-health-related outcome, such as fractures due to BMI fluctuation, has been understudied within Asian populations. In this large-scale, population-based cohort study in Korea, we aimed to investigate the relationship between variability in body mass index (BMI) and the risk of fractures. The study included 166,932 subjects aged ≥ 50 years from the National Health Insurance Service-Health Screening Cohort. The BMI variability value from three follow-up examinations during 2002–2007 was categorized into quartiles. The hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of BMI variability on the risk of admission from hip, spine, and upper extremity fractures during 2008–2015 were evaluated using a Cox proportional hazards regression analysis. Compared to those in the lowest BMI variability (1st quartile), men in the highest BMI variability (4th quartile) showed an increased risk of spinal fractures (aHR 1.21, 95% CI 1.07–1.36) with a significant linear trend (P for trend = 0.021). Compared to those in the lowest BMI variability (1st quartile), women in the highest BMI variability (4th quartile) showed an increased risk of hip and spinal fractures (aHR 1.35, 95% CI 1.05–1.69; aHR 1.16, 95% CI 1.05–1.28) with significant linear trends (P for trend = 0.021; P for trend = 0.003, respectively). There was no association between BMI variability and incidents of upper extremity fractures for men or women. Association between BMI variability and increased fracture risk depended on sex and fracture types. BMI maintenance, instead of high BMI fluctuation, may be beneficial in terms of lowering the overall fracture risk for Korean adults over 50 years old.

The primary goal of this study was to evaluate the major roles of health-related quality of life (HRQOL) in a 5-year lung cancer survival prediction model using machine learning techniques (MLTs). The predictive performances of the models were compared with data from 809 survivors who underwent lung cancer surgery. Each of the modeling technique was applied to two feature sets: feature set 1 included clinical and sociodemographic variables, and feature set 2 added HRQOL factors to the variables from feature set 1. One of each developed prediction model was trained with the decision tree (DT), logistic regression (LR), bagging, random forest (RF), and adaptive boosting (AdaBoost) methods, and then, the best algorithm for modeling was determined. The models’ performances were compared using fivefold cross-validation. For feature set 1, there were no significant differences in model accuracies (ranging from 0.647 to 0.713). Among the models in feature set 2, the AdaBoost and RF models outperformed the other prognostic models [area under the curve (AUC) = 0.850, 0.898, 0.981, 0.966, and 0.949 for the DT, LR, bagging, RF and AdaBoost models, respectively] in the test set. Overall, 5-year disease-free lung cancer survival prediction models with MLTs that included HRQOL as well as clinical variables improved predictive performance.

ObjectivesTo identify consumers’ consciousness of health-friendly products and services (consumer reaction, purchase intention and willingness to pay more) and its association with sociodemographic characteristics and multidimensional health status.MethodsFrom March to May 2018, we administered questionnaires to 1200 individuals from the general Korean population asking about their perception of health-friendly labels, and if they would purchase such labelled products (foods, pharmaceuticals, etc) and services (purifying water, preventing air pollution, etc) at extra cost.ResultsThe participants placed a high value on the importance of mental, social, spiritual and physical health factors in terms of the company’s products and services with a score of about 8 out of 10 (range, 7.74–8.33). Most respondents (72.4%) said that they were interested in adopting health-friendly labels. When a health-friendly label is introduced (such as one by the Business for Social Responsiveness), 65.1% of the respondents said that they intended to purchase the product or service, while 6.8% said that they did not and 75.0% said that they were willing to pay extra for the health-friendly product or service. Multivariate logistic regression models showed urban residence, high education level and good social health to be significantly associated with positive attitudes towards health-friendly labels. People with high income, no religion or normal weight were more likely to say that they intend to purchase products and services with health-friendly labels. They also had a more positive attitude towards paying more for such products and services, as did people with good spiritual health.ConclusionThis study provides data that illustrate the importance of health-friendly products and services to the general population and companies.

Objectives We developed the Health-Friendly Activity Index (HFAI) to measure the health-friendly activity of corporations or organizations comprehensively. We validated the developed tool and reported on its use as an assessment tool to improve consumers’ health-related outcomes.Study Design This is a cross-sectional studyPUBH-D-20-02610 Development of the HFAI questionnaire followed a three-phase process: item generation, item construction, and validation with field testing. Using relevance and feasibility criteria, we developed a 105-item questionnaire with six domains (Governance and Infrastructure, Needs Assessment, Planning, Implementation, Monitoring and Feedback, and Outcomes). To assess the sensitivity and validity of the questionnaire, we recruited two different groups. We assessed Group One (31 companies) based on their recent sustainability reports and compared their HFAI scores with the Contribution Assessment Tool for Consumer’s Health (CATCH) scores from 400 people from the general Korean population. For Group Two, we recruited 19 worksites and asked them to complete the HFAI and CATCH.Results Each domain of HFAI exhibited a Cronbach’s α coefficient between 0.382 and 1.000 for Group One and a Cronbach’s α coefficient between 0.676 and 0.938 for Group Two.

The aim of this study was to determine if multidimensional (physical, mental, social, spiritual) health status could predict the presence of depressive symptoms and suicidal ideation in the general population. We administered a population-based, cross-sectional survey to 1200 participants from the general Korean population. The survey included the 5 Health Status Questionnaire (5HSQ) for self-rated health status, Patient Health Questionnaire-9 (PHQ-9) for depression, and a question from the PHQ-9 for suicidal ideation. Multiple logistic regression was performed to estimate the association of significant socio-demographic factors and self-rated health status with depression and suicidal ideation. Physical health status was associated with depression in both men and women (men: adjusted odds ratio [aOR], 4.69; 95% confidence interval [CI] 2.44–9.00; women: aOR, 2.05; 95% CI 1.13–3.72) while spiritual health status only affected men (aOR, 5.50; 95% CI 2.59–11.65) and mental health status only women (aOR, 3.92; 95% CI 2.03–7.54). Social health status was associated with suicidal ideation in men (aOR, 4.87; 95% CI 2.74–19.99) while mental health status was associated with suicidal ideation in women (aOR, 4.31; 95% CI 1.90–9.76). Physical, mental, social, and spiritual self-rated health statuses were all found to be associated with an individual’s predisposition to depression and suicidal ideation with notable differences between men and women.

This study aimed to determine the reliability and validity of the life version of the Smart Management Strategy for Health Assessment Tool (SAT-Life) for the general South Korean population. We recruited 1,200 respondents using an equal-probability sampling method from March to May 2018. A life version of the Smart Management Strategy for Health Assessment Tool (SAT-Life) Cronbach’ α was used to determine the reliability of the 30-item SAT-Life. Comparisons with the Self-Reported Health Status (SRHS), Short Form-12 (SF-12), McGill Quality of Life Questionnaire (MQOL), Patient Health Questionnaire-9 (PHQ-9), and Satisfaction with Life Scale (SWLS) were conducted for establishing the discriminant and concurrent validity. Three sets of SAT-Life demonstrated a high reliability with good internal consistency (Cronbach’ α 0.86 for SAT-Core, 0.88 for SAT-Preparation, and 0.86 for SAT-Implementation). The total scores of the three SAT differentiated well between the before-maintenance group versus the maintenance group for achieving goals in the participants, and between the group with high depression score versus that with lower depression score in the general population. These SAT-Life scores were positively associated with health status and physical and mental quality of life (QOL). The scores of the SAT-Life were correlated with social support and spiritual well-being measured using the MQOL, and life satisfaction measured using SWLS. The 30-item SAT-Life had a satisfactory internal consistency and validity for the general South Korean population. Further validation should be carried out in a cohort study across different cultures, including an assessment of sensitivity.

Background: Accurate awareness of the prognosis is an important factor in the treatment decision of patients with advanced cancer; however, prognostic disclosure is still subject to debate because it can reduce patient’s satisfaction and increase depression. Aim: The purpose of this study is to assess whether patients’ prognostic awareness is associated with decreased quality of life (QoL) or increased depressive mood in patients with advanced cancer Design and Participants: In this cohort study, 386 patients with advanced cancer were recruited across 3 periods from December 2016 to August 2018. The outcome of this study was a change in QoL and depression according to the patients’ prognostic awareness at baseline, 3 months, and 6 months. Results: This study found significant differences in changes of QoL based on patients’ prognostic awareness. From baseline to 3 months, emotional functioning ( P = .039), pain ( P = .042), existential well-being ( P = .025), and social support ( P = .038) subscale scores improved significantly more in those with lack of prognostic awareness. Over 6 months, the group without prognostic awareness improved significantly in terms of physical functioning ( P = .037), emotional functioning ( P = .002), nausea/vomiting ( P = .048), and constipation ( P = .039) subscale scores and existential well-being scores ( P = .025). No significant difference between the groups was found in terms of depression. Conclusion: Accurate prognostic awareness may pose harm and may provide no additional benefits in terms of QoL and mood among patients with advanced cancer for a short period of time.